ࡱ> UWT'` 5bjbj$$ .BFF Y   8DT<$:000)#######$F%h'r#]wc"ww#003J$e"e"e"w^800#e"w#e"e"""0 %ɨl ^"##`$0$" (3 (" ("8}Z@e"4K,}}}##"^}}}$wwww$    Lead Project Notification Revision State of Maine Department of Environmental Protection Lead & Asbestos Hazard Prevention Program 17 State House Station, Augusta, ME 04333 TEL (207) 287-2651 FAX (207) 287-6220 FORM LR Page 1 of 1 1. Project Code  FORMTEXT       (assigned by original notification submitter) Revision #  FORMTEXT      Revision Information Submitted by Name  FORMTEXT       Mailing Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT      Lead Contractor (As listed in original notification) Name  FORMTEXT       Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       Contact  FORMTEXT       TEL  FORMTEXT       FAX  FORMTEXT       Facility Location (Where removal is to take place) BLDG Name  FORMTEXT       Floor and/or Rm.#  FORMTEXT       Physical Address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       6. Notification Revisions (Check all that apply)  FORMCHECKBOX  Change Start Date from  FORMTEXT       to  FORMTEXT        FORMCHECKBOX  Change End Date from  FORMTEXT       to  FORMTEXT        FORMCHECKBOX  Change in Work Hours  FORMTEXT        FORMCHECKBOX  Cancellation of Project Date  FORMT$%    l     * , P ľĞΘľĞľxĞjhQhR/CJUjhQhR/CJU hR/CJjhQCJUmHnHujhQhR/CJU hQCJjhQCJU hR/5CJ hR/5CJ4 hR/5CJ0 hkyCJ hR/CJ hR/5CJ hR/ hR/CJ /$%4[$If$If$If $$Ifa$ $$Ifa$$If$IfP3h45   j l yyyyyoyyoy & F$If$Ifkd$$IflF$ #* ^b0    4 la . x , h J L v(|v$If & F$Ifokd2$$Ifl40$ * !04 laf4 dh$If P R f h j t v      ( * @ B V X Z d f ~ yjHhQhR/CJUjhQhR/CJUj`hQhR/CJUjhQhR/CJUjxhQhR/CJU hR/CJjhQCJUmHnHujhQhR/CJU hQCJjhQCJU, J L ` b v x z ,.0:<NPdfhr弬弜弌|ljhQhR/CJUj,hQhR/CJUjhQhR/CJUj@hQhR/CJUjhQhR/CJU hQCJ hR/CJ hR/5CJ hR/CJ jhQCJUmHnHujhQCJUjhQhR/CJU*rt$&(N&(NPd|j hQhR/CJUjz hQhR/CJU hR/5CJ hR/CJ j hQhR/CJUjhQhR/CJUjhQCJUmHnHujhQhR/CJU hQCJ hR/CJjhQCJU+(*v*,.Nvokd> $$Ifl40<*04 laf4 dh$If$If & F$If dfhrt&(*.0fɹɩəϓ{{tdj hQhR/CJU hR/5CJ hR/5CJ!jhR/5CJUmHnHu hR/CJ j hQhR/CJUjR hQhR/CJUj hQhR/CJU hQCJ hR/CJjhQCJUmHnHujhQCJUjf hQhR/CJU'  &(<>@JLNPlnp"$&`bvxyijhQhR/CJUjhQhR/CJUjhQhR/CJUjhQhR/CJUj(hQhR/CJUj hQhR/CJU hR/CJjhQCJUmHnHuj< hQhR/CJU hQCJjhQCJU)xz,, , ,,,$,&,:,<,>,H,J,L,N,j,l,n,,,,,,,,,,,,,T-V-j-ٷ٧ٗهwjhQhR/CJUjFhQhR/CJUjhQhR/CJUj\hQhR/CJUjhQhR/CJUUjrhQhR/CJU hQCJ hR/CJjhQCJUmHnHujhQCJU,EXT       to  FORMTEXT        FORMCHECKBOX  Change in Contractor to  FORMTEXT        FORMCHECKBOX  Change in Operation (abatement methods)  FORMTEXT        FORMCHECKBOX  Change in Waste Transporter to  FORMTEXT        FORMCHECKBOX  Change in Disposal Site to  FORMTEXT        FORMCHECKBOX  Variance Request not previously submitted (Variance Request requires Department written approval)  FORMCHECKBOX  Other  FORMTEXT        FORMTEXT       _________________________________________________  FORMTEXT       Signature Print Name Date  FORMTEXT       Important Note: This form may be faxed to the Department. Remember to keep a record of all notifications sent to the Department.       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